Adventure Camp Registration | New Song Mission

Parent / Grandparent / Guardian Information

Name

First Name

Last Name

Relationship to Child

Email

Phone Number

Address

City

State

Zip

Child’s Name (First/Middle/Last)

Child's Name (First/Middle/Last)

First Name

Middle Name

Last Name

Gender

Male

Female

Date of Birth (MM/DD/YYYY)

Height (ft’in”)

Weight (lbs)

Grade

Insurance Carrier

Describe any medical conditions that your child has had in the past 5 years.

I have read and agree to the following waiver

I have read and agree to the following COVID 19 Notice and Waiver of Liability

I have read and agree to the following market release agreement

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